Pratiquer la responsabilité sociale en santé : de la théorie à la pratique. Une étude Delphi internationale.

INTRODUCTION: Health professionals’ social responsibility in health resists translation into skills that can be taught and implemented concretely in professional practice. PURPOSE OF THE RESEARCH: This study, conducted by the Réseau International Francophone pour la Responsabilité Sociale en Santé (RIFRESS), aims to develop a consensus on the components of doctors’ social responsibility in health from the perspective of experts in medical education. Its findings are intended to inform the creation of a skills profile. A three-round Delphi consensus method was used, with an open first round and closed second and third rounds. Mesydel software was used to organize the process and to do the qualitative analysis of the first round. SPSS was used for consensus analysis for rounds 2 and 3. RESULTS: Thirty-four experts responded to the study. During the first round, 62 codes emerged, grouped into 13 themes. From the initial analysis, 40 items were submitted for the Delphi round 2. Of these 40 items, 23 came out consensual after the second round, as did 13 of the 18 resubmitted items after the third. Examples of items that emerged as consensual are eco-responsibility, advocacy, defense of the common good, critical analysis of practice, and collaborative leadership. CONCLUSIONS: The present study represents a much-needed effort to concretely define the components of doctors’ social responsibility in health. Local context must be taken into account when using these findings. They can help to train tomorrow’s doctors to better meet the priority health needs of society in a profoundly changing world.

Development of a patient-reported outcome measure of digital health literacy for chronic patients: results of a French international online Delphi study.

BACKGROUND: A psychometrically robust patient-reported outcome measure (PROM) to assess digital health literacy for chronic patients is needed in the context of digital health. We defined measurement constructs for a new PROM in previous studies using a systematic review, a qualitative description of constructs from patients, health professionals and an item pool identification process. This study aimed to evaluate the content validity of a digital health literacy PROM for chronic patients using an e-Delphi technique. METHODS: An international three-round online Delphi (e-Delphi) study was conducted among a francophone expert panel gathering academics, clinicians and patient partners. These experts rated the relevance, improvability, and self-ratability of each construct (n = 5) and items (n = 14) of the preliminary version of the PROM on a 5-point Likert scale. Consensus attainment was defined as strong if ≥ 70% panelists agree or strongly agree. A qualitative analysis of comments was carried out to describe personal coping strategies in healthcare expressed by the panel. Qualitative results were presented using a conceptually clustered matrix. RESULTS: Thirty-four experts completed the study (with 10% attrition at the second round and 5% at the third round). The panel included mostly nurses working in clinical practice and academics from nursing science, medicine, public health background and patient partners. Five items were excluded, and one question was added during the consensus attainment process. Qualitative comments describing the panel view of coping strategies in healthcare were analysed. Results showed two important themes that underpin most of personal coping strategies related to using information and communications technologies: 1) questionable patient capacity to assess digital health literacy, 2) digital devices as a factor influencing patient and care. CONCLUSION: Consensus was reached on the relevance, improvability, and self-ratability of 5 constructs and 11 items for a digital health literacy PROM. Evaluation of e-health programs requires validated measurement of digital health literacy including the empowerment construct. This new PROM appears as a relevant tool, but requires further validation.

Understanding patient outcomes to develop a multimorbidity adapted patient-reported outcomes measure: a qualitative description of patient and provider perspectives.

BACKGROUND: Multimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients' and healthcare providers' perspectives. METHODS: This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process. RESULTS: Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients. CONCLUSION: Participants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.

Evaluating the content of a patient-reported outcome measure for people with multimorbidity: a Delphi consensus.

PURPOSE: Evidence supporting multimorbidity-adapted interventions is scarce, mostly due to a lack of adapted outcome measures. Measurement constructs for a novel patient-reported outcome measure (PROM) were defined in previous studies using a literature review, a qualitative description from stakeholders, and an item pool identification process. The aim of this study was to attain consensus on the content of this novel PROM. METHODS: A three-round electronic modified Delphi technique was conducted using an academic and clinical expert panel. Using a Likert scale, the panel rated the relevance, improvability, and self-ratability of each construct and item of the preliminary version of the PROM. The main outcome was consensus attainment, defined as strong (≥ 70%), moderate (50-69%) or low agreement (< 50%). Constructs and items with strong consensus were kept, moderate were sent to the next round and low agreement were rejected. RESULTS: From the 61 experts contacted, 39 participated in the first round of the Delphi, with a 12.8% attrition at the second round (n = 34) and 38.2% at the third round (n = 21). The panel included mostly female academic experts from nursing and medicine backgrounds. The preliminary PROM included 19 constructs and 70 items; from these, 16 constructs and 50 items attained consensus. The consensus attainment process excluded three constructs and their items: awareness, weight control and social integration. CONCLUSION: Consensus was reached for a patient-reported outcome measure adapted for people with multimorbidity including 50 relevant, improvable and self-ratable items categorized under 16 constructs. As more interventions tailored to multimorbidity are implemented, there is an increasing need for a valid measure of the effectiveness of these interventions.

Patients, caregivers and health-care professionals' experience with an interdisciplinary intervention for people with multimorbidity in primary care: A qualitative study.

BACKGROUND: Multimorbidity challenges the health-care system and requires innovative approaches. In 2015, a 4-month patient-centred interdisciplinary pragmatic intervention was implemented in primary care with the aim of supporting self-management for patients with multimorbidity. OBJECTIVE: To explore the perceptions and experiences of health-care professionals, patients and their caregivers with a 4-month patient-centred interdisciplinary pragmatic intervention in primary care. DESIGN: A descriptive, qualitative study using semi-structured interviews was conducted. SETTING AND PARTICIPANTS: A purposive sample of 30 participants was recruited from seven family medicine groups including patients, caregivers and health-care professionals (HCPs). Interviews were analysed using Thorne's interpretive description approach. RESULTS: Findings were grouped into the benefits and challenges of participating in the intervention. The programme allowed patients to adopt realistic and adapted objectives; to customize interventions to the patient's reality; and to help patients gain confidence, improve their knowledge, skills and motivation to manage their condition. Interprofessional collaboration eased the exchange of information via team meetings and electronic medical records. Challenges were related to collaboration, communication, coordination of work and integration of newly relocated HCPs mainly due to part-time assignments and staff turnover. HCPs part-time schedules limited their availability and hindered patients' follow-up. DISCUSSION AND CONCLUSION: This intervention was useful and rewarding from the HCPs, patients and caregivers' perspective. However, to ensure the success of this complex interdisciplinary intervention, implementers and managers should anticipate organizational barriers such as availability and time management of relocated HCPs.

A Core Outcome Set for Multimorbidity Research (COSmm).

PURPOSE: We aimed to develop a consensus-based set of core outcomes specifically for studies in multimorbidity. METHODS: We undertook a consensus study following the COS-STAR (Core Outcome Set-STAndards for Reporting) guidelines for the design and reporting of core outcome sets. A Delphi panel of experts completed a web-based survey with 2 rounds. Panelists were presented with a range of outcomes that had been identified in previous workshops and a related systematic review. They indicated their level of agreement on whether each outcome should be included in the core set using a 5-point Likert scale, and outcomes reaching a prespecified consensus level were included. RESULTS: Of 30 individuals invited to be panelists, 26 from 13 countries agreed. All 26 completed both rounds of the survey. The Delphi panel reached consensus on 17 outcomes for inclusion in a core outcome set for multimorbidity (COSmm). The highest-ranked outcomes were health-related quality of life, mental health outcomes, and mortality. Other outcomes were grouped into overarching themes of patient-reported impacts and behaviors (treatment burden, self-rated health, self-management behavior, self-efficacy, adherence); physical activity and function (activities of daily living, physical function, physical activity); consultation related (communication, shared decision making, prioritization); and health systems (health care use, costs, quality of health care). CONCLUSIONS: This consensus study involved a wide range of international experts who identified a large number of outcomes for multimorbidity intervention studies. Our results suggest that quality of life, mental health outcomes, and mortality should be regarded as essential core outcomes. Researchers should, however, also consider the full range of outcomes when designing studies to capture important domains in multimorbidity depending on individual study aims and interventions.

[The journal club as a teaching strategy to develop evidence-based practice for undergraduate students in nursing]. / Utilisation d'un club de lecture comme méthode pédagogique pour favoriser l'appropriation des données probantes par des étudiantes au baccalauréat en sciences infirmières.

INTRODUCTION: Contemporary nursing practice requires constant updating of knowledge, especially in regards to research results found in academic or scientific papers. CONTEXT: As part of the university curriculum in nursing, students must develop their skills in relation to the understanding and evaluation of research evidence. OBJECTIVES: The objective of this study was to explore the appreciation and effects of a new teaching approach, the use of a journal club within a nursing research course, with undergraduate students in nursing sciences. METHOD: As part of a qualitative exploratory descriptive design, a questionnaire with open-ended questions about their appreciation and perception of the effects of the journal club was administered to the participating students (n = 41) at the end of the course. RESULTS: Participation in the journal club appears to have provided an introduction to the scientific area of nursing, to have improved several skills related to the evaluation of scientific articles and has increased motivation to adopt evidence-based practice. CONCLUSION: The use of a journal club within an undergraduate research course in nursing was a relevant teaching method that aroused great interest in the undergraduate students in nursing.

Activation of 5' adenosine monophosphate-activated protein kinase blocks cumulus cell expansion through inhibition of protein synthesis during in vitro maturation in Swine.

The serine/threonine kinase 5' adenosine monophosphate-activated protein kinase (AMPK), a heterotrimeric protein known as a metabolic switch, is involved in oocyte nuclear maturation in mice, cattle, and swine. The present study analyzed AMPK activation in cumulus cell expansion during in vitro maturation (IVM) of porcine cumulus-oocyte complexes (COC). 5-Aminoimidazole-4-carboxamide-1-beta-d-ribofuranoside (AICAR) is a well-known activator of AMPK. It inhibited oocyte meiotic resumption in COC. Moreover, cumulus cell expansion did not occur in the presence of AICAR, demonstrating its marked impact on cumulus cells. Activation of AMPK was supported by AICAR-mediated phosphorylation of alpha AMPK subunits. Furthermore, the presence of AICAR increased glucose uptake, a classical response to activation of this metabolic switch in response to depleted cellular energy levels. Neither nuclear maturation nor cumulus expansion was reversed by glucosamine, an alternative substrate in hyaluronic acid synthesis, through the hexosamine biosynthetic pathway, which ruled out possible depletion of substrates. Both increased gap junction communication and phosphodiesterase activity in COC are dependent on protein synthesis during the initial hours of IVM; however, both were inhibited in the presence of AICAR, which supports the finding that activation of AMPK by AICAR mediated inhibition of protein synthesis. Moreover, this protein synthesis inhibition was equivalent to that of the well-known protein synthesis inhibitor cycloheximide, as observed on cumulus expansion and protein concentration. Finally, the phosphorylation level of selected kinases was investigated. The pattern of raptor phosphorylation is supportive of activation of AMPK-mediated inhibition of protein synthesis. In conclusion, AICAR-mediated AMPK activation in porcine COC inhibited cumulus cell expansion and protein synthesis. These results bring new considerations to the importance of this kinase in ovarian physiology and to the development of new oocyte culture medium.

Lifestyle factors and multimorbidity: a cross sectional study.

BACKGROUND: Lifestyle factors have been associated mostly with individual chronic diseases. We investigated the relationship between lifestyle factors (individual and combined) and the co-occurrence of multiple chronic diseases. METHODS: Cross-sectional analysis of results from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Subjects aged 45 years and older. A randomly-selected cohort in the general population recruited by telephone. Multimorbidity (3 or more chronic diseases) was measured by a simple count of self-reported chronic diseases from a list of 14. Five lifestyle factors (LFs) were evaluated: 1) smoking habit, 2) alcohol consumption, 3) fruit and vegetable consumption, 4) physical activity, and 5) body mass index (BMI). Each LF was given a score of 1 (unhealthy) if recommended behavioural targets were not achieved and 0 otherwise. The combined effect of unhealthy LFs (ULFs) was evaluated using the total sum of scores. RESULTS: A total of 1,196 subjects were analyzed. Mean number of ULFs was 2.6 ± 1.1 SD. When ULFs were considered separately, there was an increased likelihood of multimorbidity with low or high BMI [Odd ratio (95% Confidence Interval): men, 1.96 (1.11-3.46); women, 2.57 (1.65-4.00)], and present or past smoker [men, 3.16 (1.74-5.73)]. When combined, in men, 4-5 ULFs increased the likelihood of multimorbidity [5.23 (1.70-16.1)]; in women, starting from a threshold of 2 ULFs [1.95 (1.05-3.62)], accumulating more ULFs progressively increased the likelihood of multimorbidity. CONCLUSIONS: The present study provides support to the association of lifestyle factors and multimorbidity.

Motivation to participate and attrition factors in a COVID-19 biobank: A qualitative study.

BACKGROUND: The Biobanque québécoise de la COVID-19 (Quebec Biobank for COVID-19, or BQC19) is a provincial initiative that aims to manage the longitudinal collection, storage, and sharing of biological samples and clinical data related to COVID-19. During the study, BQC19 investigators reported a high loss-to-follow-up rate. The current study aimed to explore motivational and attrition factors from the perspective of BQC19 participants and health care and research professionals. METHODS: This was an inductive exploratory qualitative study. Using a theoretical sampling approach, a sample of BQC19 participants and professionals were invited to participate via semi-structured interviews. Topics included motivations to participate; participants' fears, doubts, and barriers to participation; and professionals' experiences with biobanking during the COVID-19 pandemic. RESULTS: Interviews were conducted with BQC19 participants (n = 23) and professionals (n = 17) from 8 clinical data collection sites. Motivations included the contribution to science and society in crisis, self-worth, and interactions with medical professionals. Reasons for attrition included logistical barriers, negative attitudes about public health measures or genomic studies, fear of clinical settings, and a desire to move on from COVID-19. Motivations and barriers seemed to evolve over time and with COVID-19 trends and surges. Certain situations were associated with attrition, such as when patients experienced indirect verbal consent during hospitalization. Barriers related to human and material resources and containment/prevention measures limited the ability of research teams to recruit and retain participants, especially in the ever-evolving context of crisis. CONCLUSION: The pandemic setting impacted participation and attrition, either by influencing participants' motivations and barriers or by affecting research teams' ability to recruit and retain participants. Longitudinal and/or biobanking studies in a public health crisis setting should consider these factors to limit attrition.

Existing Digital Health Technology Index Summary Report for Older Adults Living with Neurocognitive Disorders (Mild and Major) and Their Informal Caregivers: An Environmental Scan.

Digital health has added numerous promising solutions to enhance the health and wellness of people with neurocognitive disorders (NCDs) and their informal caregivers. (1) Background: It is important to obtain a comprehensive view of currently available technologies, their outcomes, and conditions of success to inform recommendations regarding digital health solutions for people with NCDs and their caregivers. This environmental scan was performed to identify the features of existing digital health solutions relevant to the targeted population. This work reviews currently available digital health solutions and their related characteristics to develop a decision support tool for older adults living with mild or major neurocognitive disorders and their informal caregivers. This knowledge will aid the development of a decision support tool to assist older adults and their informal caregivers in their search for adequate digital health solutions according to their needs and preferences based on trustable information. (2) Methods: We conducted an environmental scan to identify digital health solutions from a systematic review and targeted searches in the grey literature covering the regions of Canada and Europe. Technological tools were scanned based on a preformatted extraction grid. We assessed their relevance based on selected attributes and summarized the findings. (3) Results: We identified 100 available digital health solutions. The majority (56%) were not specific to NCDs. Only 28% provided scientific evidence of their effectiveness. Remote patient care, movement tracking, and cognitive exercises were the most common purposes of digital health solutions. Most solutions were presented as decision aid tools, pill dispensers, apps, web, or a combination of these platforms. (4) Conclusions: This environmental scan allowed for identifying current digital health solutions for older adults with mild or major neurocognitive disorders and their informal caregivers. Findings from the environmental scan highlight the need for additional approaches to strengthen digital health interventions for the well-being of older adults with mild and major NCDs and their informal and formal healthcare providers.

Performance, impact and experiences of using wearable devices for seizure detection in community-based settings: a mixed methods systematic review.

Background: There is growing scientific evidence that wearable devices for seizure detection (WDD) perform well in controlled environments. However, their impact on the health and experience of patients with epilepsy (PWE) in community-based settings is less documented. We aimed to synthesize the scientific evidence about the performance of wearable devices used by PWE in community-based settings, and their impact on health outcomes and patient experience. Methods: We performed a mixed methods systematic review. We performed searches in PubMed, Google Scholar, Web of Science and Embase from inception until December 2022. Independent reviewers checked studies published in English for eligibility based on predefined inclusion and exclusion criteria. We collected information about studies, wearable devices, their performance, and their impact on health outcomes and patient experience. We used a narrative method to synthetize separately data for each question. We assessed the quality of included studies with the QUADAS-C and MMAT tools. Results: On a total of 9,595 publications, 10 studies met our eligibility criteria. Study populations included mostly PWE who were young (≤18 years) and/or their caregivers. Participants were living at home in most studies. Accelerometer was the wearable device mostly used for seizure detection. Wearable device performance was high (sensitivity ≥80% and false alarm rate ≤1/day), but some concerns remained due to false alarms according to qualitative studies. There was no significant effect of wearable device on quality of life (QoL) measures and no study reported quantitatively other health outcomes. Qualitative studies reported positive effect of wearable devices on QoL, seizure management and seizure-related injuries. Overall, patients reported that the device, especially the accelerometer, was suitable, but when the device was too visible, they found it uncomfortable. Study quality was low to medium. Conclusions: There is low quality scientific evidence supporting the performance of WDD in a home environment. Although qualitative findings support the positive impacts of wearable devices for patients and caregivers, more quantitative studies are needed to assess their impact on health outcomes such as QoL and seizure-related injuries.

Barriers and enablers to the implementation of patient-reported outcome and experience measures (PROMs/PREMs): protocol for an umbrella review.

BACKGROUND: Patient-reported outcome and experience measures (PROMs and PREMs, respectively) are evidence-based, standardized questionnaires that can be used to capture patients' perspectives of their health and health care. While substantial investments have been made in the implementation of PROMs and PREMs, their use remains fragmented and limited in many settings. Analysis of multi-level barriers and enablers to the implementation of PROMs and PREMs has been hampered by the lack of use of state-of-the-art implementation science frameworks. This umbrella review aims to consolidate available evidence from existing quantitative, qualitative, and mixed-methods systematic and scoping reviews covering factors that influence the implementation of PROMs and PREMs in healthcare settings. METHODS: An umbrella review of systematic and scoping reviews will be conducted following the guidelines of the Joanna Briggs Institute (JBI). Qualitative, quantitative, and mixed methods reviews of studies focusing on the implementation of PROMs and/or PREMs in all healthcare settings will be considered for inclusion. Eight bibliographical databases will be searched. All review steps will be conducted by two reviewers independently. Included reviews will be appraised and data will be extracted in four steps: (1) assessing the methodological quality of reviews using the JBI Critical Appraisal Checklist; (2) extracting data from included reviews; (3) theory-based coding of barriers and enablers using the Consolidated Framework for Implementation Research (CFIR) 2.0; and (4) identifying the barriers and enablers best supported by reviews using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. Findings will be presented in diagrammatic and tabular forms in a manner that aligns with the objective and scope of this umbrella review, along with a narrative summary. DISCUSSION: This umbrella review of quantitative, qualitative, and mixed-methods systematic and scoping reviews will inform policymakers, researchers, managers, and clinicians regarding which factors hamper or enable the adoption and sustained use of PROMs and PREMs in healthcare settings, and the level of confidence in the evidence supporting these factors. Findings will orient the selection and adaptation of implementation strategies tailored to the factors identified. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023421845.

Intersectoral health interventions to improve the well-being of people living with type 2 diabetes: a scoping review protocol.

INTRODUCTION: Intersectoral collaboration is a collaborative approach between the health sectors and other sectors to address the interdependent nature of the social determinants of health associated with chronic diseases such as diabetes. This scoping review aims to identify intersectoral health interventions implemented in primary care and community settings to improve the well-being and health of people living with type 2 diabetes. METHODS AND ANALYSIS: This protocol is developed by the Arksey and O'Malley (2005) framework for scoping reviews and the Levac et al methodological enhancement. MEDLINE, Embase, CINAHL, grey literature and the reference list of key studies will be searched to identify any study, published between 2000 and 2023, related to the concepts of intersectorality, diabetes and primary/community care. Two reviewers will independently screen all titles/abstracts, full-text studies and grey literature for inclusion and extract data. Eligible interventions will be classified by sector of action proposed by the Social Determinants of Health Map and the conceptual framework for people-centred and integrated health services and further sorted according to the actors involved. This work started in September 2023 and will take approximately 10 months to be completed. ETHICS AND DISSEMINATION: This review does not require ethical approval. The results will be disseminated through a peer-reviewed publication and presentations to stakeholders.

Recommendations to address respondent burden associated with patient-reported outcome assessment.

Patient-reported outcomes (PROs) are increasingly used in healthcare research to provide evidence of the benefits and risks of interventions from the patient perspective and to inform regulatory decisions and health policy. The use of PROs in clinical practice can facilitate symptom monitoring, tailor care to individual needs, aid clinical decision-making and inform value-based healthcare initiatives. Despite their benefits, there are concerns that the potential burden on respondents may reduce their willingness to complete PROs, with potential impact on the completeness and quality of the data for decision-making. We therefore conducted an initial literature review to generate a list of candidate recommendations aimed at reducing respondent burden. This was followed by a two-stage Delphi survey by an international multi-stakeholder group. A consensus meeting was held to finalize the recommendations. The final consensus statement includes 19 recommendations to address PRO respondent burden in healthcare research and clinical practice. If implemented, these recommendations may reduce PRO respondent burden.

Case management and self-management support for frequent users with chronic disease in primary care: a pragmatic randomized controlled trial.

BACKGROUND: Chronic diseases represent a major challenge for health care and social services. A number of people with chronic diseases require more services due to characteristics that increase their vulnerability. Given the burden of increasingly vulnerable patients on primary care, a pragmatic intervention in four Family Medicine Groups (primary care practices in Quebec, Canada) has been proposed for individuals with chronic diseases (diabetes, cardiovascular diseases, respiratory diseases, musculoskeletal diseases and/or chronic pain) who are frequent users of hospital services. The intervention combines case management by a nurse with group support meetings encouraging self-management based on the Stanford Chronic Disease Self-Management Program. The goals of this study are to: (1) analyze the implementation of the intervention in the participating practices in order to determine how the various contexts have influenced the implementation and the observed effects; (2) evaluate the proximal (self-efficacy, self-management, health habits, activation and psychological distress) and intermediate (empowerment, quality of life and health care use) effects of the intervention on patients; (3) conduct an economic analysis of the efficiency and cost-effectiveness of the intervention. METHODS/DESIGN: The analysis of the implementation will be conducted using realistic evaluation and participatory approaches within four categories of stakeholders (Family Medicine Group and health centre management, Family Medicine Group practitioners, patients and their families, health centre or community partners). The data will be obtained through individual and group interviews, project documentation reviews and by documenting the intervention. Evaluation of the effects on patients will be based on a pragmatic randomized before-after experimental design with a delayed intervention control group (six months). Economic analysis will include cost-effectiveness and cost-benefit analysis. DISCUSSION: The integration of a case management intervention delivered by nurses and self-management group support into primary care practices has the potential to positively impact patient empowerment and quality of life and hopefully reduce the burden on health care. Decision-makers, managers and health care professionals will be aware of the factors to consider in promoting the implementation of this intervention into other primary care practices in the region and elsewhere. TRIAL REGISTRATION: NCT01719991.

Risk of Bias Mitigation for Vulnerable and Diverse Groups in Community-Based Primary Health Care Artificial Intelligence Models: Protocol for a Rapid Review.

BACKGROUND: The current literature identifies several potential benefits of artificial intelligence models for populations' health and health care systems' efficiency. However, there is a lack of understanding on how the risk of bias is considered in the development of primary health care and community health service artificial intelligence algorithms and to what extent they perpetuate or introduce potential biases toward groups that could be considered vulnerable in terms of their characteristics. To the best of our knowledge, no reviews are currently available to identify relevant methods to assess the risk of bias in these algorithms. The primary research question of this review is which strategies can assess the risk of bias in primary health care algorithms toward vulnerable or diverse groups? OBJECTIVE: This review aims to identify relevant methods to assess the risk of bias toward vulnerable or diverse groups in the development or deployment of algorithms in community-based primary health care and mitigation interventions deployed to promote and increase equity, diversity, and inclusion. This review looks at what attempts to mitigate bias have been documented and which vulnerable or diverse groups have been considered. METHODS: A rapid systematic review of the scientific literature will be conducted. In November 2022, an information specialist developed a specific search strategy based on the main concepts of our primary review question in 4 relevant databases in the last 5 years. We completed the search strategy in December 2022, and 1022 sources were identified. Since February 2023, two reviewers independently screened the titles and abstracts on the Covidence systematic review software. Conflicts are solved through consensus and discussion with a senior researcher. We include all studies on methods developed or tested to assess the risk of bias in algorithms that are relevant in community-based primary health care. RESULTS: In early May 2023, almost 47% (479/1022) of the titles and abstracts have been screened. We completed this first stage in May 2023. In June and July 2023, two reviewers will independently apply the same criteria to full texts, and all exclusion motives will be recorded. Data from selected studies will be extracted using a validated grid in August and analyzed in September 2023. Results will be presented using structured qualitative narrative summaries and submitted for publication by the end of 2023. CONCLUSIONS: The approach to identifying methods and target populations of this review is primarily qualitative. However, we will consider a meta-analysis if quantitative data and results are sufficient. This review will develop structured qualitative summaries of strategies to mitigate bias toward vulnerable populations and diverse groups in artificial intelligence models. This could be useful to researchers and other stakeholders to identify potential sources of bias in algorithms and try to reduce or eliminate them. TRIAL REGISTRATION: OSF Registries qbph8; https://osf.io/qbph8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46684.

Implementation model for a national learning health system (IMPLEMENT-National LHS): a concept analysis and systematic review protocol.

INTRODUCTION: Despite efforts and repeated calls to improve the organisation and quality of healthcare and services, and in view of the many challenges facing health systems, the results and capacity to adapt and integrate innovations and new knowledge remain suboptimal. Learning health systems (LHS) may be an effective model to accelerate the application of research for real quality improvement in healthcare. However, while recognising the enormous potential of LHS, the literature suggests the model remains more of an aspiration than a reality. METHODS AND ANALYSIS: To reach a fine understanding of the implementation of the concepts involved in LHS, we will use a hybrid method which combines concept analyses with systematic review methodology. We will use a two-step analysis, a content analysis to analyse the definitions, uses and attributes of the concept and a systematic review to analyse the concept's implementation mechanisms. We will search eight databases and grey literature and present a broad synthesis of the available evidence regarding design, implementation and evaluation of LHS in a multilevel perspective. We will follow the latest Preferred Reporting Items for Systematic Review and Meta-Analysis statement for conducting and reporting a systematic review. Two reviewers will independently screen the titles and abstracts against the eligibility criteria followed by full-text screening of potentially relevant articles for final inclusion decision. Conflicts will be resolved with a senior author. We will include published primary studies that use qualitative, quantitative or mixed methods. The assessment of risk of bias will be made using the Mixed-Methods Appraisal Tool. ETHICS AND DISSEMINATION: This systematic review is exempt from ethics approval. The results formulated will highlight evidence-based interventions that support the implementation of a national LHS. They will be of particular interest to decision makers, researchers, managers, clinicians and patients allowing finally to implement the promising proposal of LHSs at national scale. PROSPERO REGISTRATION NUMBER: CRD42023393565.

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review.

BACKGROUND: Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations. OBJECTIVE: This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations. METHODS: A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions. RESULTS: The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023. CONCLUSIONS: This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50798.

The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis.

BACKGROUND: The majority of people with a chronic disease (e.g., diabetes, hypertension, COPD) have more than one concurrent condition and are also at higher risk for developing comorbidities in mental health, including anxiety and depression. There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services. The aim of this study was to conduct a meta-analysis of the digital mental health interventions for people with comorbid physical and mental chronic diseases to compare the effect of technology systems and level of support. METHODS: This secondary meta-analysis follows a rapid review of systematic reviews, a virtual workshop with knowledge users to identify research questions and a modified Delphi study to guide research methods: What types of digital health interventions (according to a recognized categorization) are the most effective for the management of concomitant mental health and chronic disease conditions in adults? We conducted a secondary analysis of the primary studies identified in the rapid review. Two reviewers independently screened the titles and abstracts and applied inclusion criteria: RCT design using a digital mental health intervention in a population of adults with another chronic condition, published after 2010 in French or English, and including an outcome measurement of anxiety or depression. RESULTS: Seven hundred eight primary studies were extracted from the systematic reviews and 84 primary studies met the inclusion criteria Digital mental health interventions were significantly more effective than in-person care for both anxiety and depression outcomes. Online messaging was the most effective technology to improve anxiety and depression scores; however, all technology types were effective. Interventions partially supported by healthcare professionals were more effective than self-administered. CONCLUSIONS: While our meta-analysis identifies digital intervention's characteristics are associated with better effectiveness, all technologies and levels of support could be used considering implementation context and population. TRIAL REGISTRATION: The protocol for this review is registered in the National Collaborating Centre for Methods and Tools (NCCMT) COVID-19 Rapid Evidence Service (ID 75).